Episode 1: Out of the Shadows - A Jewish Approach to Mental Health

There are challenges that affect so many, and yet so few talk about them, which is why Rabbi Ephraim Goldberg and Moshe Yachnes bring you Out of the Shadows, a Jewish approach to mental health. Rabbi Goldberg and Moshe speak to leaders in the field and discuss contemporary issues to help us better understand mental health and those who are struggling with it. On this inaugural episode, we are joined by Dr. Norman Blumenfeld, Director of Trauma, Bereavement, and Crisis Intervention at Ohel Children's Home and Family Services. Rachel Tuckman, a licensed mental health counselor. Dr. David Pelcovitz, a world-renowned expert and the Gwendolyn and Joseph Strauss Chair in Psychology and Jewish Education at the Azrieli Graduate School of Jewish Education. And Elisheva Liss, licensed marriage and family therapist who specializes in helping individuals and couples improve their quality of life and relationships. We hope you find this episode meaningful and helpful, and be sure to check out the show notes for resources. Moshe, this is a really exciting moment. You and I have worked together so closely and for so long, and the opportunity to collaborate with you, Boca Raton Synagogue and Onward, and to expand our Adopt partnership and to try to bring this conversation through a podcast, I'm really, really excited to be working together. Yes, good evening. Shavua tov. Good vach. We are really eagerly as excited. I think it's going to be so helpful for so many people, really to instill hope and some practical um understanding of of a very complex and confusing topic. We we want to express our gratitude to AB and Ariane Winepearl, members of the Boca Raton Synagogue, who tragically lost their son Johnny, Jonathan, a beloved, amazing young man, and took their pain. I'll never forget at the funeral, AB pulled me aside and said, "Rabbi, I want to put resources into making a difference. I don't want anyone else to suffer pain." And they've done that through Onward, Boca Raton Synagogue, through this Adopt, and this podcast is just the next step of doing that and making that difference that we know already is having an impact on people's lives. So, a big thank you to the Winepearls. Yeah. And and the truth is, I remember sitting in their living room and really having a discussion around, you know, the Winepearls getting involved and and helping and giving back, and it was just so authentic and so, you know, amazing how they've taken, you know, their their struggle and really using it to to help others and to perpetuate the, you know, the this issue, and it should be a tremendous chos for, you know, for his neshama, and we're excited to to really remove the shanda and and and continue talking about this. Absolutely. So, you and I work closely together on on several cases, and and I consulted and each of us in our own arena, I as a rav and you as a therapist, and a leader in in that area and industry. So, why are we doing this? You have an enormously busy practice in several centers, and baruch Hashem, we have a large kehillah, we have a very large shul. Why why are we doing this? We're not making money from this podcast, we're not promoting or expanding a brand, and we have no aspiration to be influencers. We're doing this for one reason one reason only, that is in our conversations and consultations with others, what can we do? We're seeing an explosion of mental health challenges, mental illness, one of the issues we'll discuss, the difference between the two, and and we're trying to come up with what can we do? And one of the things that emerges from every conversation is the shame and the stigma and the shanda around mental illness, mental health. People don't talk about it, they're ashamed of it, they're embarrassed to go to family members, to their rav, to ask, to explore, to admit. And the more that we can have these conversations, the more, as the name of our podcast suggests, people come out of the shadows, then the more that they can be helped. And and Moshe, you've you've told me that. So, talk a little bit about where shame hides and what happens with it. Yeah, I mean, we always say in the rooms, you know, shame dies in public. And and when people can build enough confidence and comfort and and and security around their struggle, that's the beginning steps towards the recovery process, towards the resolution. And and you know, what's what's amazing is there's so much sophisticated talent in our community, our broader community, our macro level community, of the solution. I I think we've done a tremendous job on the awareness side of things as far as, you know, that there are challenges that exist, and you know, part of this agenda is to really help people understand that there's a road map, there's a solution um through continuing the conversation and through exploring various different channels, they can find serenity and peace and work through whatever's going on, whether it's an acute, you know, comprehensive um you know, very sophisticated challenge, or whether it's a baseline anxiety that is affecting their functionality of on any level. Um so, we're excited to bring on various different guests over the next uh year or so um with very specific um platforms that they themselves have. One of the things that we've seen um just in in in our centers to be able to get a kind of like a high-level um representation from communities like Los Angeles, like Chicago, New York, New Jersey, Cleveland, Toronto, Eretz Yisrael, we see people coming from these markets and from these places, and we're in touch with different leadership and askanim and therapists and rabbis, and we're noticing certain trends, certain patterns um that there is still a stigma around these issues, and there's, you know, through those conversations, we're also identifying there's a there's tremendous amount of help available. So, the agenda here is in a very humble way to uh to really continue the conversation, bring it to our homes, bring it to our Shabbos tables, have have a very clear understanding that through talking about it, we can really chip away and and find the the the resolution. Yeah, we're not romanticizing mental illness, we're not celebrating it. Uh what we are saying is that it's real and it's here, and there's no one no one's done anything wrong who has it. In the same way you wouldn't sit in judgment if you saw somebody with a cast or a bandage, if they wore their illness on the outside, you would jump in to say, "How can I help? Do you need help walking or carrying those books, or can I carry your coffee?" Uh this is invisible, and that's a big part of it, and there's there's shame connected or attached to it. And if our conversations and our podcast episodes, one by one, will tackle different topics, anxiety, depression, ADD, OCD, and others, and each one to bring an expert in that area and to talk to people who are going through, have gone through, and solution-based, what can we do? Action items, not simply to wallow in it, not simply to validate, although it's important, but to actually talk about practical things that we can do. That's our goal. Our goal is to validate that you've done nothing wrong, we've done nothing wrong, those who are going through. I could tell you as a rav, as a rabbi, I could tell you as a regular person. I sometimes joke that the pharmacist uh after the rabbi, maybe before the rabbi, knows more about what's going on in the community than anybody else because ein bayis asher ein sham, there's no home in the Orthodox, in the Jewish, in the general community today that someone's not taking something, a little help they need to maintain attention, ADD, or to overcome some anxiety, mild or significant, severe, or any and many other examples as well. But people are still apprehensive and hiding when they pick up the prescription or they take the medicine, they send their child to camp, to yeshiva, seminary, school, or or on shidduch resumes. And and they've done nothing wrong. This is a world where the data and the statistics bear out that this is proliferating and exploding. So, whatever small part we can do in these conversations, and tonight's really exciting to speak to four real, prominent leaders, experts who have a holistic view of what's going on and can give us some insight to start this conversation. We hope that you're listening, you'll share it with others, maybe you're listening with someone who can gain, maybe you need to gain the confidence and to know now it's okay. It's okay to turn to someone you can trust that you haven't done anything wrong, and and the community's here here to help you. So, Moshe, maybe talk a little bit about your centers and and your experience, so where you're coming from when you speak to to this topic. Yeah, so I mean, thank you. You know, we are it's really about the the marriage between both platforms here, you know, the rabbinic um you know, is is an address. When people in our community are in crisis, they seek counsel from the rav, from the leadership in the community. We ultimately know derech eretz, derech eretz noam, uh the secrets towards happiness isn't found in the Torah. Um and there's also science and and and a lot of really evidence-based protocols that we're learning about and understanding um best ways to build a road map towards recovery. Um so, yeah, I've been in the space uh 20 years now, um really seeing a a full spectrum from acute um psychiatric presentations all the way towards baseline, I would say, common anxiety, uh disruption of what normalcy and and and day-to-day functionality. And and you know, it's really just looking at that over over the last two decades, seeing trends, um seeing certain similarities, you know, there are certain profiling, you know, items that we can identify and really project issues down the road. Um and tonight is really about launching uh that conversation to really to give people a a global brushstroke around the various different topics, put some language to to what's going on, giving people the tools that they can then take to their professionals, to the local leadership, and explore explore themselves, empower them to be able to get the help that they need and that they so desperately deserve. And and what to look for within ourselves first and foremost, if we're not healthy, we can't help others. And what to look for within our families and how to react and how to respond. When when you and I were younger, I'm probably I look at least much older than you. When we were younger, people often brushed many of these kinds of things under the carpet, under the couch, they didn't talk about it, they didn't acknowledge it, they didn't validate it. Um and and it wasn't it wasn't healthy. I think in future generations now, um people are suffering as as a result, and and we've learned a lot. So, let's apply that learning to be able to to come out of the shadows. It's a great honor to be joined by Dr. Norman Blumenthal. Dr. Blumenthal, thank you so much for sharing your your wisdom and expertise with us as we launch this new podcast and try to expand the conversation about mental health and taking the stigma away. You are synonymous, not in any one location, but really nationally and internationally, in helping communities dealing with with trauma and crisis and major major mental health issues. So, our first question for you tonight is in your experience, how prevalent are mental health issues in the Orthodox community, the Jewish community? Is this something which is still an outlier? Is it a minority? Have mental health issues, to whatever degree and whatever level of of challenge, have they really spread? How have they changed in in your career or over the last several years, can I say decades, what have you seen are the trends in in the expansion of of mental health issues and the presentations of it? Well, if we talk about my career, it's been huge. I mean, it's gone from a time when people looked at it askance and thought that you know, we can just through religious observance, we can avoid mental illness or or psychiatric conditions to a real recognition to the point that you can go to a Nefesh conference today and there's streimels and there people from every walks of life working the field of mental health. It turns out it's much bigger program that Dr. Pelkowitz and I teach and which is training the Mashgiach in basic mental health counseling skills, mental illness. So, there's been a a huge change. I'm not going to say there isn't still some stigma and and certainly we live in a fishbowl and people are very more self-conscious probably in our community about how they appear and how their family appears than in other communities, but we've made tremendous gains, really huge gains. That's in how we're addressing it. What about in terms of how it's being presented? If X percentage of every class had kids with ADD or adults with anxiety, that that data and the statistics show that we have multiples, right? It's exploded even before Corona and certainly COVID accelerated it. So, are you seeing that and how do you see that within within our community? Sure, I think it's in every community, but we're seeing it in our community. We're not immune. I think what's happening and I think this might be the sort of colossal change that I think is already begun and probably going to see more of is that I think the whole paradigm of the provision of mental health services in the community is shifting. I wouldn't say it's changing, I'll say it's shifting. The old model was one of you um you know, you identified the person in the school, in the workplace, in the community that had a mental health issue and you make a referral. The level of problems, particularly in schools, but even in the community, especially with anxiety and especially since COVID, has is escalated so much that instead of identifying the individual and bringing him to the mental health professional, mental health professionals are going into the community. Mental health professionals are going into the family and there as I said, there's a shift from identifying the individual, taking them to the mental health professional to more of the mental health professional entering into the mainstream setting and providing with provision of services and deputizing people in the past would not have been mental health professionals to take over some of the work in the area of mental health. Let me give you just a few examples. Ohel has a MAP program. MAP stands for Middle School Anxiety Prevention Program. I believe we're in 10 schools in the New York area now and a handful schools in South Florida. And what we're doing is we train teachers and administrators about anxiety and how to manage moderate levels of anxiety and how to prevent anxiety, how to do certain stress management in the classroom. So, instead of our again, identifying the kid with anxiety, bringing him to the mental health professional, though those with extreme anxiety still need it, we're actually deputizing the teachers to to be the providers of mental health services. We're more and more we're deputizing parents. There's a program out of Yale called SPACE which in which instead of treating the child with anxiety, they're training the parents how to be the treatment providers. So, I think this is a shift and I think it reflects the levels of emotional psychiatric difficulties that we're facing. Would you say that those shifts are because there's actual behavioral shifts as far as the you know, the general community or there's more of an awareness and more of a organized strategic affront to address them? In other words, is your average individual growing up more anxious in actuality or we're more equipped as a community to address it thereby presenting it, you know, to give them the tools to to help to work through it? Or a combination of both perhaps. Right, I think there's actually three issues. I think yes, there is a greater awareness. I think there is much more anxiety. My own personal bias is I'm not the only one who says this, but I think that it's partly the result of technology of the proliferation of anxiety technology because everything comes so easily. Everything is so tailored to us through technology that we've lost the coping mechanisms and we're we're finding that we have to actually in a very didactic way train children to manage difficulties that many in the past, let's say when we were young, we learned through the school of hard knocks, social skills. Nobody taught us social skills when we kids, we learned them after we got beaten up three times, you know. It was that was social skills training. You know, the Italian kids down the block gave me my social skills, you know. The the but today we train children in social skills cuz everything sort of comes to them. The other issue that I think is specific maybe to schools and I think it's very important is that we don't need teachers anymore to be to be the perveyors of information. Any child can click a mouse and find out much more than the teacher even knows. So, the the role of the teacher is shifting. The first of all, technology is part of the classroom in many, certainly in the more modern schools, there's computers and teachers they're going back and forth, but I don't need the teacher to tell me who won the Civil War, I can ask Siri. So, therefore the role of the teacher is changing and the teacher is becoming much more involved in the emotional well-being and the social well-being. They're still educating, they're still teaching children how to use this medium, but their whole role is changing as well. So, we're piggybacking on that and we're telling the teacher, okay, this is anxiety, this is depression, this is OCD. If it's really out of hand, send them our way, but if it's manageable or if you see it, you know, in its incipient stages and can exercise an element of prevention, here is how we do it and that's I think the shift that takes place. I think it's for those three combined reasons. You know, for schools it's nice to see Schools schools do well when they schools are excited to say that we're addressing it in these ways, but on the individual level and you know, you see it a lot and we'll talk about in future episodes, the impact of of mental health, mental illness in the world of shidduchim for example. But are you still seeing resistance and shame and stigma and shanda because you know, there are families who are still trying to brush under the carpet or let's not admit we take medicine, let's not diagnose or call it what it is. If we avoid that, we can pretend we don't have it. And how do how do we avoid that because there are people struggling and suffering in silence, they feel alone, they feel invisible and when they're afraid to admit it, then they're they're much more vulnerable of suffering from it. Sure. Well, we one of the ways we stop it is that podcast like this and to your credit, this is this is this is a giant step. You know, there's the old line that the only problem marriage solves is being single. It's you know, that and and you know, there's no shame. You know, if you're not going to have you're going to have shame about having asthma, if you're going to have shame about having eczema, then have shame about anxiety or depression. The they're they're comparable. These are elements that you know, one one might affect the skin, one might affect the the respiratory system and one affects central nervous system. And so, I think that's part of the recognition. The other thing that I think is important which is a theme I try to develop in but more cloistered way maybe than you are, is that if you you take any of the I'm not talking about the extremes of mental illness. Let's let's let's let's put aside schizophrenia, bipolar, some of these more severe disorders. And again, with full sympathy for the individual and the family who are dealing with this, but if we take depression, we take anxiety, we take OCD, when managed, a lot of these conditions that if out of control or if hampering our lives are disabilities or disorders, managed or channeled in the right direction can be assets or strengths. So, there's a very thin line between being depressed and being sensitive. There's a thin line between being anxious and ambitious. There's a thin line between OCD and being thorough. I know a Posek who told me that he's he knows he's OCD, but he channels it to writing Sifrei Halacha. Um There's a very thin line between being paranoid and being a very good litigator. So, a lot of our clients Excellent excellent points. I mean, can you talk a little bit more in detailed about how an individual can differentiate between you know, something like an OCD or being, you know, proficient or anxiety and being productive, etc. etc. Can you talk a little bit about how an individual can identify for themselves or a loved one or family member so they themselves is there is there like a self-check way practically for an individual to to to get some clarity around these very complex topics? Well, I I I think if I dumb it down, um and I don't mean to be insulting to the audience, but just to make it simpler, um it's Is it in control of you or you in control of it? So, in other words, is your Is your depression owned Does your depression own you and you're unable to function or are you channeling that heightened emotionality or that ability to connect with human suffering? So, that you can visit the sick in a meaningful way, that you can offer consolences to people who have suffered losses. Um it's you're mobilizing it. I remember once I was in a lot of my work is in the area of bereavement and certainly parental loss of a child and I remember once running a group where someone where there was a woman who had lost a child 5 years ago and there was a woman who was in the first year and she was trying to explain to her what it's like now 5 years later and she said, "I now wear my grief around my neck in a package. And when I need it, I reach in and I access it." And and that's really That's the mastery of it. I'm actually still grieving. That's an amazing way to conceptualize it. Wow, beautiful. Really clear. And it wasn't mine. I'd love to take credit for it, but it was really what the my real teachers, which is the people who open up and trust me enough to share their their innermost secrets and and that Yeah, and I think that's what we're talking about. Um that you take the tendency and you channel it in the right direction. So, it's not maybe a classic curing like with the illness where you have an infection and you take an antibiotic and it goes away. We take it and keep help you understand it, master it, and use it in construction constructive fashion. You know, it's interesting. We definitely see that so much of that in the recovery, you know, when it comes to recovery from addiction where it's that the power of self and the ability to hone a skill set and channel in the right direction, uh the perseverance, the the work ethic. Um they've done everything to numb and escape and now when it's re-categorized almost you know, internally, they've been the most productive, uh you know, successful people. So, would you say that the majority of healing can take place from within uh with with that context? Well, healing it's interesting. Well, almost all human growth isn't it a personal endeavor. Um it's very hard to sort of grow on your own. We don't you know, sometimes I I I tell people that I'll give you a simple example. Uh you know, you go to the store and buy a suit and you stand in front of that three-way mirror. If you can't believe you know, so my nose is that big. You know, you we don't even know what we look like. Um it's through our interaction with others that we learn about ourselves and that we can experiment with growth. So, yes, it does come from within, but it's usually prompted and nurtured. And in the personal context, that's why therapy. It it is is interpersonal nature. You know, it's funny you mentioned addictions that one of the questions I sort of pose sometimes when I teach the Smicha students at YU is is the Masmid an addict? You know, the guy who just can't tear himself away from Seforim who suffers Tisha B'Av morning because he can't get near his Seforim. Is he an addict? Now, I I can get in a lot of trouble for saying that, but I'm just saying again it touches upon how sometimes the very same tendency channeled in the right direction can be a strength. You said something extraordinary to me. The the example you gave about wearing it around the neck and taking it out is and it's so important for our podcast and our goals for the conversations we're going to have as we tackle different topics is that these aren't necessarily issues or presentations that are going to be solved or cured, they need to be managed. Right? So, where's the bar and where's the goal? The goal is not to declare that you're illness-free or that you've conquered it or that it's gone. If if you think it is, you're probably very susceptible and vulnerable to getting it back. The goal is does it own you or do you own it? Are you managing it? Is it managing you? Which is such a different bar and it's such a different goal to set at the beginning of the conversation and it seems to me it's an it's one that can be accomplished. It's it's a standard that a person could try to pursue is that right? I'm not trying to cure or I'm not trying to make sure it's gone to a matter I'll never live without it. How could that be? So, why bother starting versus yeah, this is a part of my life. I'll live with it. But, you know, there are people with diabetes. I have someone in our community who has diabetes and gives himself insulin shots as he does an Iron Man competition at least once a month. So, you you could have diabetes, manage it, and be in much better health than people without it. Question is are you are you managing, which is such a different paradigm for how you're addressing. And for our audience who who are struggling, be it anxiety, be it something else is you don't have to dream of not having it. You just have to dream of being in control of it. Right. Channeling it through channel. I tell my patients all the time, "I'm not going to change you. I'm going to make you better at who you are." And and that's what I do. I can't change people. it it it could actually be it could turn into it could turn into an ego strength actually and they can use that that ability to persevere as a you know, as a as an internal kind of building block for for further challenge and and and deeper work as they continue to to you know, to process and and work through those those different areas. Sure. Absolutely. Again, and it makes it then you know, again it's it's not a denial of who you are. It's it's just a taking who you are and putting it where it belongs sort of. Let me ask you one last question. I I know you work a lot in trauma. Right. Are are we underestimating how much trauma COVID did to all of us? That the average person who didn't lose a loved one and maybe wasn't in the ICU, but whose kids were on Zoom and was working from home and whose life was turned upside down. Is there underlying PTSD collectively we're all going through that's undiagnosed that we're not speaking about and that is presenting and is going to present in ways we don't even appreciate yet? It's a loaded question. In fact, it's interesting the new book that just came out by George Bonanno, who's a prominent grief specialist out of Columbia and it's called The End of Trauma and he challenges how much we define things as trauma and how much of it is really life stressors or challenges and are we are we over-pathologizing some of the challenges that that that are posed in life? Um I do believe that COVID has been a game-changer in many ways. Um I think it has changed our perspective on health and the provision of health. For some people, it's even changed some of the trust they have in the government. I'm not going to go there, but for many people in terms of how it was managed, it does it has changed their perspective. Let's say in terms of the government overseeing our health and that that the people have feelings about that, which of course I'm not going to take a side. Certainly remote uh provision of services, uh telehealth, um providing therapy over over Zoom, having business meetings over Zoom, um not having to be in the actual vicinity of where you work. I think that has that has changed as well. Um and um you know, I think our vulnerability uh I I believe that before COVID hit, I think there was a certain invincibility we felt because of technology and all that we can do, you know, that we can pick up cell phone and talk to somebody at the other end of the world, that we can get on the computer and just maneuver and manipulate things um and and we felt invincible and I think we it would be unthinkable that would be any kind of illness that we couldn't very quickly figure out how to solve and solve very quickly. And the fact that it really shut down the world for a significant period of time has humbled us and I think has sort of made us feel and maybe that's some of the anxiety and some of the tension that we're seeing that we're not as with all of the advances we've made, we're not as invincible as we thought we were. Beautiful. You know, Rabbi Doctor, another beautiful framework to think about trauma and it's probably a podcast onto its own um is is not necessarily the traumatic experiences that destroy people, but it's the relationship with those experiences. And if we can kind of pivot or rewrite the relationship with those events, it could it could empower a person. It could really help them, you know, move through it. So, Sure. It's great. No, I think I I think there're going to be some very positive outcomes as a result of I mean, there was unfortunately had to be illness and with so much death and devastation, but I think there will be, you know, the world will be in in many ways. I think already it's starting to happen, um a better place as a result of what we we we went through. I know for myself, for example, half my practice today is remote. That would have been unthinkable before COVID. And it's had to it's forced me to rethink how do I how do I provide therapy as a two-dimensional image, you know, and it is a change. It's a different type of therapy and I'm I'm not finished yet. It's it's a process I'm going through at home as well as all of my colleagues, I believe are going through. I'm sure you're going through, Al Shul but but it it'll come to the point where we're going to we're going to perfect that and that'll broaden our capacity to reach people reach people in remote places uh and make connections that in the past would not have been possible and that's probably one of the the silver linings Yeah, seeing the positive. It's a healthy way to try to recover. Doctor Willmenthal, thank you for your your experience, your wisdom. Thank you for your time. And we're we're looking forward to continuing these conversations around these topics in in future episodes and we appreciate it. Rachel, thank you so much for joining us to have this important conversation that we're trying to bring to the community or expand within the community. Um we know about your vast experience in in New York with kids and teens, adults, with women in particular. Um and we want to draw into it to better understand and to define something. So, people who are going through can give a name and better understand where to go and find solutions. So, maybe coming right out, help us understand the difference between mental health and mental illness. We'll talk about the proliferation of mental illness issues in the community and then we talk about what are we doing for our mental health. Is everybody who's struggling or getting anxious do they have mental illness? Um can you mental health help us define our terms and better understand these trends? Okay, so I think that that is really important because I think a lot of the reason that people are not getting the help they need is because they're not understanding the difference. Um so mental health is something that everybody has. We all have mental health. It is our well-being, it's our thoughts, it's our emotions, it's our social connections, it's how productive we are, it's our ability to have healthy relationships, our ability to adapt and change to adversity. We all have mental health. Mental illness on the other hand, not everybody has. Um it affects the way that people think, behave, and interact with others and themselves. They'll have significant changes in their thoughts and behavior when someone is experiencing mental illness, and they'll also have significant impairment in their functioning. And And when we use the DSM, when clinicians use it, I personally in my practice, I try not to use it very much, but it is a good guide when we're trying to give context to certain behaviors and and um patterns. But when we use the DSM, we're looking one of those main criteria is how is it affecting a person's life? And that's kind of how we determine if this is an illness versus kind of just a phase of life thing or just general stress or just, you know, there's a difference between feeling depressed and depression, feeling anxious and having anxiety. So it's important. There's a difference between mental health and mental illness. And so just like we all have physical health and we get illnesses sometimes, it's the same thing here. We all have mental health and sometimes people get ill with a mental illness. And just like illness impacts our ability to be healthy and function properly, it's the same thing with mental illness. And just like you can treat a physical illness, like even a chronic condition, let's say, like diabetes or MS, um you know, we we know that there's medications and lifestyle changes and things like that that make it very possible medica- medications interventions that make it possible for you to live with this illness, the same goes for mental illness. So you can be someone who has bipolar or schizophrenia, a mental illness, and you go to therapy, you take your medications, you make sure you manage your stress. You make sure you get that sunlight and movement, and you actually perform better or manage your life better than someone who does not have a severe diagnosis. They don't have a mental illness. And I think that's important for people to know. Mental illness does not mean you fail in life. It does not mean you cannot function. It's something that could definitely get in the way, just like if you don't manage your diabetes or your MS or your chronic, you know, your cholesterol or whatever it is, it's the same thing here. Um it's important to know that poor mental health can lead to mental illness, right? If you're more susceptible to it, if it's in your family genetically, right? There's a huge genetic component. It's something to to be mindful of, you know, that it could um manifest later in life. But again, if we understand that, you know, just like a medical medical condition, sorry, medical condition can be managed with proper medication and going to the doctor and saying, "Hey, like here are my symptoms, here's what's going on." And we can get the right treatment. I I really want us to see mental illness in the same way. Let me just jump in with a quick follow-up question before you come in, which is how does a person themselves know, how do they know if they're generally mentally healthy, just anxious because it's the high holiday season, school has started, there's all kinds of pressures, or whether in fact they're confronting a spike, something more significant which is diagnosable? How how would a person sense that themselves? And to reinforce that and to reinforce that, Rabbi, is that anxiety actually is a motivating factor for a lot of people. When a person get those envelopes in the mail, you know, that that those bills drive them to to work every day. Um you know, so how do you differentiate between healthy functioning anxiety that propels productivity versus uh you know, a pathological or or critically impaired, you know, anxiety? Right. And that's that's such an important point because yes, anxiety, I often tell clients that I work with in with anxiety, the goal is not to get rid of it completely because anxiety serves a protective function. Yes, it gets you to prepare that speech, it gets you to practice before that game, it makes you look both ways before you cross the street. We want anxiety, but we want healthy levels of it. And by the way, even feeling nervous before school is actually a really healthy thing. But if your anxiety, let's say with the school example, you cannot get on the bus, you cannot get into school, or when you get into school, you're completely up in your head all day, "Oh my god, I don't know anything. I can't learn. I don't understand what the teacher's saying. I can't handle homework." And so you get home at the end of the day and your mom or dad is like, "Hey, how was it?" And you're like, "I don't remember a thing. I couldn't pay attention." That's where we would say, "I think that your child needs help." Or if you're in school, or if you're in your job even, and your boss is talking to you and it's kind of like that Snoopy, you know, that Snoopy character comic where he hears the person talking and it's like, "Wah wah wah wah wah wah wah wah wah wah wah wah wah wah." If that's what you're hearing at work all day because you're terrified about your job performance, so you can't even get your job done, I would say that might be a time where you're constantly ruminating and worrying. And And I think also when you're worrying about things that are probably not even going to happen. And I think that's the difference, too. If you're worrying, "I'm nervous about school, I want to do well. I want to do well in my job." That makes sense. But if you're like, "My boss is going to hate me. I'm going to get fired. Everyone there is going to, you know, make fun of me and laugh at me." I I don't know that that's reality, and maybe that's something we need to to explore. So it's about like the intensity, it's about the content of the thoughts, it's about how it's impacting your life. Are you still able to show up with that anxiety? Because that matters. And by the way, even if you're able to show up at work, but you're obsessing all day or terrified all day, I would say it's still worth talking to someone. You know, what is it doing to your body to constantly be in that heightened sense of fear, fight or flight, those cortisol levels out of control? It's not good for you. So that's where I would say, if you feel like it's beyond your control, that there's nothing you can do to stop yourself, to calm yourself down, or to get whatever is going on around you under control, that's where I would say reach out for help. You know? Yeah, so it's a basically it's a functionality paradigm that you're looking for. Um is that something that, you know, you could explore internally with a family member or a spouse, or is that something you would say needs further analysis and deep consultation about? I think if you have a support system, that's great. But I think, you know, I often say like my I have kids who I am proud to say go to therapy and have asked, "Can I see a therapist?" And their mother is a therapist, right? And they will often say to me, my my teen daughter will say, "But you're my mom, you know?" And when she'll come back from a session, I'll say, "What did your therapist say?" She's like, "Exactly what you told me." But it's different when it's not her mother. She She might feel like when I'm saying it, "Yeah, but you're my mom, so you're supposed to encourage me or you're supposed to help me see things differently. I don't want to hear it from you. I want to hear from someone who's not invested in like making me feel fantastic because she's my mom, you know? And so I think sometimes we need that objective voice so that we can hear it better and kind of feel like, "Well, you're not getting anything from making me see this differently, you know? This is not It doesn't affect you either way. You don't go home at the end of the day and like have to deal with me." So I think sometimes that helps to have that objective outsider, someone who's not seeing everything um and doesn't know all the ins and outs, that sometimes they can have a point of view that maybe a family member can't have. And that's I think that's the value in therapy, someone who doesn't know all the little bits can sometimes see the picture better, you know? What are you seeing in terms of the stigma that surrounds mental illness and mental health? You have a relatively young practice. I remember a couple years ago a trend of of teenage girls in particular where it was almost in or cool to have an eating disorder. You were only somebody if you were struggling and everyone knew it. Um so on the one hand, with young people, maybe there's a cool factor which which obviously is is not something which is healthy. And on the other hand, the older you get, there seems to be a stigma surrounding it. I don't know your practice. Do people um hesitate to overlap in a waiting room? Are they staggered in terms of being able to see you? Are they very Are they fearful and dreading anyone finding out that they need therapy, that they're getting help, that there's any mental illness? In In our future episodes, we're going to explore all these things, particularly in shidduchim and so many other arenas and areas. But what are you seeing in terms of a stigma attached to this? So I think it depends. I have I think I have clients that are kind of all over the spectrum. So I live in the Five Towns and I work in the Five Towns, and I work specifically in the Jewish community. That is something I want to do. It's something I feel passionate about. It's where I live, it's where I'm raising my family, so I feel like this is where I want to make the biggest impact. So I specifically do not want to go outside of this world. And even on social media, I I know I have many non-Jewish followers, but I actually speak a lot to the Jewish community. Um and you know, that's kind of where my my passion is. So I have clients who, you know, will see me in Gourmet Glatt and run the other way. And then I have clients who will see me and be like, "Hey, you know, how are you?" Clearly we have a boundary of we're not going to talk about our session in the meat aisle, um but they can definitely see me and acknowledge me if they want. I've had parents who have brought their kids to me and say like, "I do not want anyone to know she's here." Which I, you know, always find concerning, and I'll kind of have that chat with them of like, "Just so you know, there's a trickle-down effect. If your child feels like there's something shameful about coming in this room, that will affect the work they do and that will affect how they're feeling about themselves. So just like you're not embarrassed to bring them to the doctor for their checkup or because they have strep or to the eye doctor, this should fall under that same category, something you need that is good for your health and that ensures that it's not just an intervention, it's a prevention. We see there's a problem and we want to make sure that it doesn't get worse, and this is what we do because we love you and care about you. So I kind of have it all over. I do find though that with the teens that I work with, it's actually so much less stigmatized than when than I think it's safe to say we're probably all in the same kind of generation within, you know, 5-6 years. Growing up, I know when when you found out someone was in therapy, you were like, "Ugh, like nebbish, like what's going on in the house? They're a problem child." It's so different now. I have teens who literally, if I had a business card, they would be giving my business card to their friends. They talk about their therapists. "Oh, who do you go to? Oh my god, my therapist told me." That's a common phrase among teenagers now. "My therapist said." Which back day never would have been spoken. If you went to a therapist, you lied and said you had a dentist appointment, right? Like you did not say where you were going. So, I think with teens it's very different. Again, I have some teens that do not want anyone to know they come to me, but for the most part I see a difference in the younger generation, even a little bit with the older. But I think if we talk more openly about, like I said, like if we understand mental health and we say there's no shame in asking for help. No one knows how to do everything. You know, I think we've kind of gotten the memo like most parents don't know what they're doing, so we read parenting books and we listen to podcasts and we're not embarrassed about that anymore. I wish we would feel the same way too about anxiety. Dealing post-COVID, like my kid is a mess or I'm a mess or my marriage became a mess and I feel like I need help. I think that we're getting there very slowly. We definitely need more conversation and I think this this forum right here is such a huge piece of how that's going to happen. Open conversations with I think also religious leaders, rabbis, people in the community that say, "Hey, I'm talking about this. I want to help. This is important." And I think that's something that we haven't done before, you know, and we're starting to do. That's actually that actually dovetails into our second question for you today this evening is what is, you know, what's the primary role of a community or of a rabbinic figure or educational institution in the context of mental health? What what's their primary agenda? Can they do something differently or increase certain things that they're doing as far as policy to help that individual? You're working with the individual one-on-one. Is there certain trends or shifts that you're seeing more on a macro level, you know, to to create an environment, you know, role of community in the context of mental health? Can you can you talk a little bit about that? So, I think certainly with COVID, and I'm sure you've all seen this, we saw a lot more conversation about the impacts of mental health and even and and halakha halakha acknowledging that halakha working around that halakha dealing with it, right? So, I think that those conversations were very helpful and kind of helping people understand that in the Jewish community this is something that we really do care about and we want to talk about. So, I think rabbis giving shiurim about that stuff, and I know Rabbi Goldberg, you do talk a lot about mental health. Um so, I wish that there were more people that were doing that, you know, I know in my community in the Five Towns in Woodmere near at the Young Israel of Woodmere, we definitely have a lot of it. Um I would love if more communities would do that. Stand up in shul, talk about mental health from the pulpit. Give people resources in your community. Have awareness shabbatons. And I know this can be sensitive, but there are people in communities that want to tell their story. So, if you can put a face to a struggle, someone stands up and says, "I had a child that died by suicide. My son struggled, you know, with learning issues. My daughter had an eating disorder. My, you know, I had to deal with X, Y, and Z addiction. If we put a face to a struggle, very often people I think a lot of people assume everyone's life is perfect except mine. Only my life is stinky. Oh, look at their gorgeous house. Look at their beautiful children. Look at their beautiful I'm lucky that every day, lucky not lucky, double-edged sword, I see that that people's lives are never what they seem. So, I'm reminded every day that like what I have I I should be grateful for and that people struggle. I struggle. Everyone struggles. But I think people forget that. And so, when they see there's someone that's just like me that I assumed has it better than me, but they're telling me that they had a struggle too that I can identify with, it creates this feeling of I'm not alone. I don't have to feel ashamed. There's nothing wrong with me. Someone who I thought is genius and amazing and their life is so great, they're also having an issue in this respect. And I think that that would be really impactful for people and open conversations, you know? Um I just think that that's that's something that communities can do to even remove stigma, you know, talking openly about these things more um is really the key, you know? And and I think also this is important that um community leaders know where to send people when they're struggling, you know, instead of and I I don't know this cuz I'm not a rabbi, but I understand that you wear many hats, you know? And sometimes people will come to to rabbis by default and they'll want kind of like a therapeutic relationship and it's it's just not A in terms of time, B in terms of ability, and it's I've had rabbis say to me like, "This is like way above, you know, I can't do this." Um and so, I say, "Give them names. Have resources handy that you say, 'Hey, this is an issue that I cannot help you with because I don't have the skill, but I want you to get the help you need. Here's this marriage therapist I know. Here's this, you know, therapist who works with kids. Here's this who to have that ability to be a resource for your community in that way also. I think it also relieves some of the burden for you of a lot of counseling that you don't have to be doing, right? I think up to a point there's you know, some kind of guidance you could give and then I think it's time for us to be able to give rabbis the permission or community leaders the permission to say, "Hey, I'm going to refer this out to someone who could really give you what you need." You know. Absolutely. That that's enormously accurate and helpful. Yeah. I know that when people come to me, um I tell them I'm not trained. I'm not an expert. I will complement and supplement Yeah. and I will refer you. And, you know, the rabbis, what we used to call, I guess our generation still knows, the Rolodex, but making sure that you have an active um list and you know, Moshav for me is an enormous resource uh helping me directly and indirectly being able to refer me to give people referrals, but it's easy to come to the rabbi. The rabbi is in charge. There's no stigma to meet with the rabbi. In fact, people praise that. And the rabbi at the end of the hour doesn't punch the clock and say, "I'm so sorry, our time is up." So, it's easy. And that's where a rabbi also can get almost intoxicated on feeling I'm helping and there are rabbis who slipped into that uh inappropriate position of almost somehow getting something out of the how needed they are and the difference they think they're making. Absolutely, we need to empower to know when to refer, how to refer, what to offer when complementing, when we are referring. These are all fantastic fantastic suggestions and we can't wait to continue the conversation in general and and with you. Thank you for sharing your experience and your wisdom with us this evening, Rachel. Thank you. Thanks so much. Dr. Pelkowitz, thank you for being with us. You cannot have a conversation about the state of mental health, mental illness in the Jewish community, the Orthodox community without talking to you. If there's anyone who's our collective authority and and we all know Dr. Pelkowitz is admired across the spectrum of the Orthodox world, the Jewish world, and well beyond. And that's not an easy thing to do today. I think it's really a testament to to you. And but it also puts you in a position to really provide us a bird's-eye view of some of the trends that you're seeing, some of the changes, maybe earlier career to to more recently, the last few years. Are are you seeing more mental health issues, mental illness presenting itself in individuals, among families, in schools, in shul life? What what are you seeing and what can we learn from it? Sure. Well, And and just that to piggyback on that, first of all, it's great to see you again, good luck, but as far as COVID, are you seeing COVID as a contributing factor or there was there was an arch overriding that how does COVID play a role as well? Right. And that's that's that was going to be the first point I was going to make is that had you asked me this question before COVID, I would have given a much more positive reply because among the positive changes have been um a uh a increased receptivity to to getting mental health support. Uh there seems to be less of a stigma. It's not uncommon for um people to see me in shul and to say, "Oh, hi. By the way, I'm going to be coming to your office next week." And and in front of in front of a million people. Or when I see younger people for them to go to my children or grandchildren and say, "Oh, but you know, we'll be going to your house a little bit later this week." No much less shame than there had been. On the other hand, um since COVID, there seems to have been um we're not we're not immune to the explosion, you know. Um one positive resilience builder, I think, is that we have um we we have a very clear um kind of strong social network. You know, to the extent that we live in an overgrown bungalow colony, um everybody is uh pretty much um pretty much they're they're for each other. Uh people who have been able to continue to go to shul to the extent that the situation allowed it as the the COVID situation has resolved a little bit, um you know, it's made a tremendous tremendously positive kind of difference. Many schools, I don't remember what the various schools in your um neighborhood have done from a policy standpoint, but I think you guys kept going for um Yeah. Florida. We're in Florida. We're in Florida. You're in Florida. Right. Right. So, much much less much less of a shut down. America. We're in America. You're in America. The real America. The real America. So, um I think that's made a real difference. Um you know, um you know, the key with uh issues like anxiety or depression is to the extent that you could avoid avoidance and face your fears, um you're going to be doing much better. So, to the extent that you could get some mastery by facing your fears, people are going to do uh much better. On the negative side, um there's um a real um I think intensification of um uh shifts in parenting in terms of uh snow plow parenting, panu derech, clear clearing the way for um for um you know, our children or grandchildren in a way that they shouldn't have to God forbid suffer in the least in the least bit. And that's been um you know, that that's that's something that I I haven't seen any improvement in. Uh you know, there really is um a a massive shift in parenting. I think it in in the world, but we see it maybe a little bit on steroids in our community. So, Dr. Pelkowitz in in this proliferation both before and certainly during Corona, what what's presenting the most? Is it anxiety? Is it young people, older people? And And the people with anxiety, is is there a lot of shame? Are Are people willing to admit at work, to friends, at shabbos tables? And is the shidduch stigma a big overarching factor? Do no families want to admit it's in their family? Yeah, so let's take it a a step at a time. In term In terms of anxiety, I think that people are openly speaking about it. I I've done some uh talks on anxiety um in various communities, and the turnout is um is really almost shocking um how many people come. From From older, younger, um there's um there was a talk I gave um just a little bit before COVID to show you how this predated COVID. Um where there was pouring rain, like horrible rain. And so, I figured um you know, maybe me and the host would be the only ones to come. And I get there, and there there was no parking for like a five block radius. Um and and and um it was uh standing room only, and believe me, it had nothing to do with me. It really wasn't. It was the topic. People are um very concerned about the rise in anxiety both in themselves and in their children. So, I think it's uh it's uh transgenerational. As far as uh depression, um I I think it my my impression is that um anxiety is more on the rise than depression is, but that's not necessarily um so uh so much based on um so much based on on hard data. Um but but for sure, I would say that um the the that double-edged sword of um mood regulation disorder, both anxiety and depression, seems seems to have been on the rise especially since COVID. As far as uh shidduchim, um that's probably very much dependent on uh neighborhood. Um you know, there's a um I think growing awareness um that there's a real need for us to uh view it as uh something where no say ba'al, you know, where we're all um you know, on the bottom of the hill trying to uh share and and and thinking of people. And um it it it for a while, it it it seems to be a pattern where when communities become really aware of the need for them to go beyond um beyond being passive about it and to actively look for ideas, um it really works. You know, one of my kids just did his third shidduch. It was after the olam haba thing. Um but he was so excited just by the success of number three that, you know, it it it's something that you already see spreading to his whole cohort of friends. Um so, I think that that there's um you know, there it's true, there's still all kinds of silly kinds of um emphasis on the wrong um on the wrong issues, um but at least in my neighborhood, which is a little bit more of a modern neighborhood, probably very similar to Boca, um um I hope that's not an insult. Is that a compliment or an insult? We're good. We're good. Okay, good. So, um I'm seeing that there's a um there's a real openness to talking about it, and um you know, unfortunately, there's some very sad situations. Um the head of once mentioned to me that um he he can't get over how frequently he has to do taharas on women who have never been married. Um now, that might have been happening going back over the millennia, but um it's just such a painful thing to hear that. Um and um you know, uh there's you know, it's a very complex area, but it's something that I think is definitely on the agenda, and to the extent the communities and people listening to this podcast recognize that this is something that um you know, the the olam haba you get for finding even one shidduch is um is is unbelievable. You know, to change uh to change uh the world that way. So, and it's not it's just a matter of uh you know, figuring out how to uh say what you need to say in terms of not being embarrassed about talking to somebody. Um obviously, boys, it's uh men, it's much less of a of a problem, but for women, unless they have anxiety and they're perfectionistic, we see that also. But um you know, for women in particular, there's um there's a real need that we have to be able to uh move on this. Mhm. Do Do you think that we'll ever get to a point that um people will see mental illness like physical illness? I I'll never forget there was a someone in our shul who had shared with me, he doesn't live here anymore, that his son who struggled in school, some personality challenges, some learning issues, and he said to me, he said, "You know, Rabbi, he got picked on in school. The kids were cruel. Teachers were insensitive." He said, "I often think if my son broke his leg and were in a wheelchair, the other children would run over to carry the books, to help him. The teachers would be flexible and understanding. But because his injuries were internal and invisible, because his challenges you couldn't see with the naked eye, he got picked on and bullied instead." And it broke my heart when he said that, and that that's part of the goal of our podcast and part of the goal of of bringing mental health out of the shadows is that the same way you wouldn't sit in judgment with somebody who had God forbid cancer or diabetes or or asthma, why are we sitting in judgment of people who are struggling with anxiety or OCD or or ADD? And why why do people have to hide that, apologize, be defensive, or feel any sense of shame around it? What What could we be doing as a community to to make mental health more like physical health? If I showed you a picture of um somebody um who was hurt physically, like you show a car door um slamming on somebody's fingers, you would automatically wince. You wouldn't have to think about it for a second. Or I show you a piano lid of a piano smashing on either kids' or adults' fingers, immediate wincing. It requires absolutely no no effort whatsoever. But if then I showed the same group of people a video of people who were being socially excluded or being um you know, uh in a group of kids on a WhatsApp chat, um you know, um you know, uh we're on a Friday afternoon, um everybody's getting together for pizza, but you're excluding the kid who's a little off or a little weird or a little bit spectrumy or a little bit just sort of um on the periphery for whatever reason, it takes much more active effort to be able to see that. It takes It takes literally, that's the whole idea of being no say ba'al um chavero, of of being there. But what I find is that when I speak to groups of parents and even of kids about this, and make them aware of the tremendous cost of um of exclusion, of bullying, and how um it literally could uh scar could scar somebody uh some of the research shows for a very long period of time. And you make them aware of it, I find that the average person um is going to do their best to try to work on it. I I have a lot of faith in in our community. Our community is um is I think really um uh it's made up of people who really do care. Sometimes because of the rush in our lives and because of our um being so pressured, we don't see what's in front of our eyes. But look, this is um Elul time, right? So, uh you know, one of the thoughts in terms of the word Elul, it means um it means to um search, right? It says "Yassuru aretz, yalulu." The Targum says in Shlach. So, it's the time of searching, but then there's Elul backwards, which I learned from um my um from my um uh step sister, Orly Cannor. Um you know, that it's lulei. It's the it's the Elul backwards, it's the what it's the evonot. It's becoming aware of ways that we mess up. And now's the time of year to really think about that. To really think about um how uh sometimes very simple kinds of um awareness um about um how we either could save a world by being there and by reaching out. Um I I just had a quick vision that came to my mind. I was I don't know why I was thinking of this, but I was at a shiva. Um um And it was the shiva of a man who was a very fine man. But was known to be an incredible athlete. He died after a long, wonderful life. But he was an amazing athlete. And practically everybody who came to be menachem avel had a story about how even though they were not terribly good athletes, and even though they were pretty bad at playing baseball or playing basketball or football or whatever, um this man always showed them first. Okay? And saw to it that they were included. And it was amazing to me. There were so many reasons to have remembered him. He had been president of our shul. He was the leader in a million different areas. He'd been an officer in the Navy um and maybe a bit of a war hero. Nobody talked about that at the shiva. What everybody talked about was how he watched out for people who were always made to feel a little bit less than because of um areas that that um uh you know, that that many people just just don't pay attention to. So Yeah, I mean, that's the that's the agenda here is to be able to just to lean into that natural capacity for empathy and sympathy, to be able to lean into the the next person, you know, sitting next to you in shul or next to you at the dinner table at the Sunday barbecue. Uh to to just be aware essentially is what you're saying. Yeah, yeah, exactly. And that can do so much to to to mitigating these issues. Yeah, and and you know something? And and and it's as simple as a smile. As simple as, you know, saying, "Hi, how are you doing?" It may not feel like much, but, you know, eye contact, the k'mayim panim el panim, you know, having our souls bounce off somebody else's soul. Um my wife um whenever we walk to we walk she's an aveiles this year and she walks to shul every morning. We walk together. Uh so, she could say uh she she could say kaddish. And every single person she sees, she says, "Good morning. How are you?" with a big smile. And it seems to have changed People love it. You just see people um it it it changes and now when we walk, there's like, you know, everybody is uh it's it's it's sort of that little thing seems to have changed the atmosphere of our, you know, 7/10 of a mile walk every every weekday morning. You know, so it's something to it's something that um it it it's not it it doesn't take a lot. It doesn't take a lot. It's it's really remarkable, Dr. Pelkowitz. We're speaking to a great researcher, clinician, expert in our community. And you know, it's not a wonder drug and it's not a certain type of therapy. What we're basically saying is that we can tackle a lot of mental health if we're just nice to each other. If we smile to each other. If we just create a culture in a community of less judgement, less marginalizing, more inclusivity, more smiling, more favorable judgement, more understanding. There's so much of of the response and improving mental health is in our hands. It doesn't have to cost a penny. It's not about a therapy or a treatment. It's just about how we treat one another. I could lose my I could lose my license for making things sound too simple, you know? But um you know, and for not making it more complex. But the reality is I really I really believe that's the essence of this. You know, it's the equivalent of of uh of uh just just being there. You know, it's it's uh you know, being is And and And if I could just say one more thing about this. Um I am amazed at how people often underestimate this aspect of interpersonal relationships. In other words, you know, they'll say um you know, they they they might have been extremely helpful to somebody when they had a loss or when they were ill. And they might have gone to to the hospital to visit or um you know, or just called to make sure that they're saying, "Maybe I could pick up some groceries for you." And then they're shocked when people um respond with tears of gratitude and and happiness. You know, this week's parsha, right? I I know that I I don't want to make this too narrow. But this week's parsha, you know, we're talking about the power of gratitude. The power the power of um of being able to um um use that to um to to basically energize um our our being there for everybody. So, um yeah. the answer the solution the key's in our hands. And even the empathy. I I once called I once called Dr. Pelkowitz I once called you for a very difficult, complex issue going on in the community in my life. And I'll never forget what you said to me. I don't know if you remember, but you said to me, "You know, that's a really, really tough question and and I don't know if I have the answer, but I'm standing next to you and I'm going to climb the mountain with you." I didn't know what you were talking about and then you told me, maybe you could share now that piece of research about how people feel the steepness of of the mountain. But that that makes all the difference in the world, right? So, a person who's looking up at anxiety or depression or they're looking up at whatever form of mental challenge and they feel alone, will feel it What What was that study that you shared? It's um they take people and they put them at the bottom of a hill. And they say, "Estimate the steepness of this hill." If you're alone, you see the hill is very steep. If you have somebody at your side, the hill will look less steep. And the closer you feel to the person at your side, the less steep the hill looks and the less tired you get walking up the hill. But even to to to bring this to another level, um that that goes with stigma as well. The same researchers found that if you unburden a secret that you're holding on to. And it may be the secret of suffering with a mental illness, suffering with bipolar illness or with um schizophrenia or with any of the variety of ways that um you know, the challenges with mental health that life could bring our ways. Uh our way. And if you could just be there and feel that you could unburden yourself and you're not alone, the researchers find that once you do that, the whole world is going to look less steep to you. Okay? You're going to feel you're going to have that same energy. And that And that's So, Rabbi, should we give Should we Should we give everyone some homework this, you know, this Elul? To just be more empathetic and say hello to their neighbors? Is that something that's Yeah. Yeah. And that'll go I I keep a permanent record, okay? Of uh you let me know how everybody does. Okay? We'll report. We'll report back to you. But it does If you If you care about this issue, if you want to come out of the shadows, and we want neighbors, family, and ourselves to feel better, you know, part of the answer the therapy's in our hands by just being nice. Just smile. Just be positive. Judge favorably. All that All that kind of good stuff. Dr. Pelkowitz, thank you for giving us your time, your wisdom. Um thank you for all that you did for Klal Yisrael on a regular, regular basis. And we're looking forward as we continue to tackle different topics in future episodes to be able to turn to you. So, thank you so much. And thank you for all that both of you do. It's been It's It's been an honor that you included me in this. Thank you. Thank you. Thank you. Alicia, we're so grateful for your time. Thank you for joining us as part of this project on Out of the Shadows as we try to tackle mental illness, really more mental health without stigma or shame and address some of those issues. And and we've worked together and and we've had the privilege to interview you before and want to tap into your wisdom. So, thank you for being with us. The The first question I want to ask is talk to us about mental illness, mental health, specifically not only in the Jewish community, but the role of halacha, of Torah, of Orthodoxy, of observance. Does the fact that we are so attentive to detail, keeping kosher and taharas hamishpacha and yom tov and Shabbos meals, and all the area of Halacha, and for some, you know, they joke the neurosis or the Pesach syndrome. God forbid not to indict us anything negative about a system that is elevated and enriched and empowered us, but how can we be aware at least of maybe why we're a little bit more vulnerable? Do you think it has impacted and in what ways and how could we be aware of it and respond to it? It's a very rich question. I feel like we could talk for an hour just on that question. Um I I think, you know, um there there's a story that Dr. Edith Eger tells at the beginning of her book The Choice. Um I I I hope I'm going to remember it correctly, but it was something along the lines of a team of psychologists was sent to the DP camps. And if one of you read the book and remembers the story better, then please correct me. But um I I think one of the psychologists was describing how she was so concerned cuz like there's no literature on how you treat people who just went through a Holocaust. Like there was, you know, they were they didn't know what they were doing. So, they figured, "Okay, they'll go and they'll try to help and they'll do the best they can without really, you know, having a lot of research to back them up." And so, when they got there, they started talking to these survivors, these, you know, kind of gaunt, traumatized, shocked survivors. And um they were fascinated to find that what most of them wanted to talk about were things like, you know, um a man would come and say, "You know, there's this woman I met in the DP camp and I can't figure out if she likes me back." Um you know, the same the same human issues that that people who hadn't just gone through a Holocaust had, you know, were coming up. And that doesn't, you know, not to mitigate the amount of trauma that came up for sure. Um but my dad, who's a psychologist who I, you know, love and respect very much in a completely biased way, but he'll also he's brilliant, um says that you know, sometimes I'll talk to him about a cultural issue that comes up and he'll sigh and he'll say, "You know, Shav, people are people." So, um yeah, I think that that our culture, our our um values, our priorities, our lifestyle becomes the stage on which a lot of our mental health concepts, struggles, experiences, um and and resources uh play out. Um you know, I somebody sent me a clip once from I I don't know what show it is, but it's a must be like a contemporary uh TV show where there was a person who's acting who's acting very very erratically. And somebody went goes up to him and says, um did do you think maybe you should go talk to a psychotherapist? And the guy says, looks at him quizzically and says, "You know, I'm not a Jewish man." So, I thought it was a cute stereotype. You know, but we we you know, joking about it aside, we we do have a lot of multi-generational trauma. Um not to say that other subcultures don't. Um but I I think that specifically because we care so much, you know, we care so much about life and values and Halacha and relationships and serving God and morality, um we have very strong feelings, you know, and these are generalizations. I don't know that I'm really a person who can make distinctions between, you know, Orthodox public or even the Jewish public and and the other because the vast majority of my uh therapist career has been spent uh serving religious communities, mostly Orthodox communities actually. And so, I don't have really a great um uh you know, a a great comparison, a great frame of reference to compare outside of religious communities. But from what I'm seeing in terms of like the literature that's coming out there in the broader world, um mental health, just like politics, just like um social awareness is polarizing. Um and so, what we think about in terms of what's the point of life, what how do we run our relationships, how do we how do we temper the chesed and the gevurah in terms of ourselves, our relationships, ourselves, our relationship to God, our relationship to relationships, what we expect out of relationships is something that the that from communities are struggling with the same as um you know, as as the global community is struggling. I feel like I'm talking a lot. Do you want to interject? Sure. Yeah, no, it's it's an amazing point. It's just interesting cuz the experience of Yomtov is really a Pesach Seder, it's all about family system, it's all about the continuation of the legacy, etc., etc. And yet we see anecdotal research that post-Yomtov is when the pathology comes out. Um you know, being, you know, preparing for the different Yom Tovim is when that, you know, some of the OCD stuff comes out. So, it's interesting because the way it was set up was really to to tackle this head-on and really to to to create happiness and simchas chayim and all of that stuff, and yet at the same time very often is is when there's a focus on these experiences is when we're seeing an increase in in challenges and in family fights, etc. Yeah, so you see it maybe more publicly in Yomtov. Um we see it, you know, I'm a couple's therapist, so I I see it a lot playing out um around the niddah laws, around, you know, going to the mikvahs is a big OCD. It's like literally a whole workbook on tackling mikvah OCD. A lot of um what they call scrupulosity, um you know, focusing too much. There's a beautiful teshuvah by I think Rav Asher Weiss on, you know, how to how to address um the OCD in the in the realm of Halacha. Um you know, something that's really interesting that I think has happened in the last few decades, you know, in the last century, is that we've become so much more aware of larger worlds and smaller worlds, you know, like other galaxies out there and like, you know, subatomic particles and microorganisms. And like I I think that having such a big context for where we fit in the world or knowing how how small we are in the world creates this sense of sort of like an existential angst at the macro level and um a sense of like homing in on tremendous amounts of detail at the at the micro level. Um and we're seeing that like, let's say, a germophobia OCD, right? Which is not specifically connected to religion at all, could translate into focusing on the minutia of Halacha. Um you know, obsessional OCD where people are, you know, kind of like figuring out who am I, what am I, my relationship, you know, like a philosophical, which doesn't specifically have to be religious, um will translate into, let's say, I, you know, I don't know if I said Shema properly, I got to stick around for an extra hour and a half saying it a few more times just to make sure. Um you know, so you have like again at the macro and the micro levels, people just kind of like thinking so much. And you know, the healthy version of that is, you know, we want to be thinking and feeling and davening and and working on ourselves and growing, but it can it can become a neurosis. And and that's that's definitely something we want to we want to watch. Um you know, Can I ask a very basic question? Cuz you referenced your work with couples, and it's really for both of you, but I'll ask Shavva, is a couple who's struggling or in crisis, where does that fit into the definitions of mental illness and mental health? Meaning, it may not be anxiety, OCD, ADD, bipolar, schizophrenia, the you know, the classic list of of diagnoses or issues that people are facing, um it's it's two otherwise mentally healthy people, but who aren't healthy together because they need counseling, sometimes intense, sometimes less so, sometimes real crisis. Is that is that a mental health or mental illness issue, somebody who's seeing a therapist in that context? So, it's a good question. Um you know, Rachel Tuchman, I know you interviewed her for this also, and I sometimes we talk about how part of what we hope and daven for as far as destigmatizing the topic, talking about the topic of mental health as is trying to look at it as less of a dichotomy and more of a spectrum. Um you know, instead of like, well, there's the mentally healthy people and then the mentally ill people, right? Um we all exist along a continuum, right? The same way like if you would use, it's not a perfect analogy, but you think about physical health, right? We don't think of people as Well, there's people who are 100% physically healthy and there are people who are, you know, 100% medically fragile, right? Most of us have bumped into some health issues along the way. Even people who are very healthy probably had like strep throat at some point, right? Um and and, you know, maybe have little things, you know, my feet hurt sometimes, you know, things like that um that may have diagnoses, you know, subclinical syndromes or or bigger issues that we struggle with. Um and and we go through tekufos, you know, different time periods where it's like, "Oh, you know, she has some issues with her back. She's considering getting surgery, you know, working through different health issues." And you can be a basically healthy person who's going to see a doctor about a particular pain or uh you know, syndrome or condition or injury that you're dealing with. And it's not so different when we're talking about mental health. And I think learning to look at it from a more layered and nuanced and dynamic perspective rather than like, "Oh, these people are mentally stable and those people who, you know, well, they're they're struggling." That's not, you know, I think that that others people, you know, it kind of like makes it more stigmatized and scary. So, just in terms of like redefining what mental health is is that it's a phenomenon. Everyone has some mental health. And you know, if we define mental as like stuff that goes on in the brain, right? Like things that go on in our minds and in our in our hearts and our feelings, then we're all going to struggle with that sometimes, right? Sometimes we get angry about things and we want to calm down. Sometimes we get really sad about things and we want to cheer up. And you know, it's not uh you know, my my training is I'm an LMFT, which is a very not clinical approach. It's a much more relational, systemic type of approach. Um and so, I was trained to look at human experience as much more in the context of relationships than in the context of diagnoses, which doesn't mean that there's never a place to talk about diagnoses. We absolutely need to know and understand and deal with diagnoses. But when a couple comes for therapy, sometimes we're dealing with a specific individual diagnosis, right? So, like um one of the parties is having panic attacks and they're coming for couples therapy because the panic attacks and the anxiety are affecting the dynamic of the relationship or of the family. And so, then the individual who's dealing with his or her own individual struggles needs individual treatment. And then the couple's therapist comes in and helps us helps like kind of navigate what's going on within the relationships. And then part of the relationship is what is what the mental health struggles are. Um so, that's I think how I would sort of define that, but I I think when you're dealing with people who are um motivated and self-aware, then even when someone has like a diagnosis of anxiety or depression or some other thing that you would find in the DSM, um you know, if a person, you know, I it's going to sound a little simplistic, but I feel like middos are a big machria. You know, like if a person's saying like, "I own what my behavior is and I recognize that it's coming from my OCD and I see how it's impacting my relationship. Um you can work really beautifully with that. Yeah, that's great. And and and I guess to take that question to the next level when it comes to, you know, the the the role of school, the role of community, the role of a shul, how does that interplay with the individual struggling? And again, it's on that spectrum, right? So, they might not be going through complex trauma, they might have had a a scary experience or or an alarming or a unnerving experience. What happens that individual when they walk into shul or when they they're going to that that student that walks into the classroom? How do you see the interplay between the the more systemic platforms and the individual themselves? So, I think if I'm understanding the question correctly, yes, cut me off in the middle if I'm not. Um but I I I think what we're looking at is sort of that bio-psycho-social continuum, you know, and I would add spiritual. Right, is that what you're that's what you're referencing? Exactly, yeah. Yeah. So, For people to understand that that we don't right, we're we're we're we're we work within a context. So, an individual has a family and that family has a community and that community right, so that's that's what we're trying to help you know, folks understand what what what that connection is and what the interplay is. Yeah. I was actually recently doing an intake with someone who had a horrific trauma and he said that after the trauma, what what he viewed as even more traumatic was the the denial and the lack of support and the victim blaming that he experienced when he came to the it was he was a young person and when he came to the adults in his life who were supposed to be there to sort of say we believe you and we're here to protect you and we're going to confront the person who hurt you, it was handled so poorly and this is not an indictment of any particular community. That that that kind of, you know, inappropriate response can happen in any community anywhere. We all know this and it's, you know, and thank God I think the world at large and our community included is making great strides in terms of educating lay people and leaders and institutions as far as being able to be resources rather than God forbid to make things worse. But, you know, we are still dealing with the the PTSD of of people who have had really awful experiences. But, I'm sorry, you were saying something like outside the scope of of of horrific experiences, even more minor stressors that a person might be dealing with. So, going back to that, we're we're each a composite of our biology, which is our our genetics and what's going on in in our neurotransmitter activity in our brains and our in our bodies, our physical health, which is also very much connected to our mental health, um our our psychological self and and the word psyche is actually it means soul. So, even though in contemporary secular psychology, they talk about it more from sort of a sociological point of view of just like what goes on in a person's like thought process and consciousness, but really soul is is a spiritual notion, right? So, it's the psyche, right? The the interplay between our you know, kind of neshama self, our minds and our our hearts and our feelings and our the way we conceptualize who we are and what we do in this world, right? The social, the interpersonal, the relational piece, um you know, and I think also the spiritual. So, that's everything like you said so nicely like it's embedded in a context. So, if you think of it as sort of like the nucleus, right? The where these concentric circles, right? There's the middle of the nucleus, right? The person and God within that person, right? Cuz there's the soul. And then and then there's the immediate like nucleus nuclear family, right? Whether it's a family of origin if a person's still living with parents or or family like your one of the executive, you know, the parents and the children. Then there's you know, extended family, friends, and neighbors, community, rabbinic leadership, mentorship, close friends. And you know, sometimes people will have relationships split out. They might say, oh, I'm closer with my neighbors than I am with my family of origin who lives across the world. It doesn't really matter so much what the official title of the relationships are. It matters more the role that these relationships play in a person's life. You know, so when a person goes into a school or a shul, um I'm a believer and people feel differently about this, but I'm a believer in individual responsibility. You know, I feel like if you know, if I walk into a shul or school or a meeting or a community, like it's it's my job to like sort of present myself in ways that are appropriate and boundaried and contributive. You know, I have to regulate myself. If I can't regulate myself, right? I'm going through something and somebody observes. They're either concerned about me because they're noticing that like they're a concern that I might be in in danger or they're concerned that I'm I'm not interacting in ways that are healthy with other people, right? So, you know, I guess like that's part of like both the beauty and the pathology of our community is we really care a lot about each other. Right? Um and and so the question then often becomes how do we get involved? And I think that our community has done, you know, has made huge strides in terms of like creating organizations and structures and frameworks and educational opportunities for lay people and for leaders and for educators to become more and more savvy, psychologically savvy and knowledgeable and sensitive to to be able to kind of scope out and sense like reach out to people and say, hey, is everything okay? You don't seem yourself these days. And try and network. You know, when when I do my intake with clients, very often I'll say, oh, can I ask who referred you to me? And so often it was, you know, my rabbi, my college teacher, my teacher from high school that I keep in touch with. So, very often members of the clergy, you know, rabbinic and and religious mentors are the first line of intervention. So, It's good to hear. That's a that's a positive sign that people are that people are doing that. I want to ask you we may have time for one more question, which I think is a very very important one. You spoke about the spectrum that it's not either or or this dichotomy. The language that we use is important and you'll hear you'll hear children today. A teenager might say, stop telling me to clean my room, you're giving me anxiety. I'm not studying for a test, it makes me anxious. So, we're we're using and abusing clinical words which disrespects or does a disservice or dilutes its meaning for the people who really are suffering with it. So, is is that your experience or you finding in the vernacular and in the culture that because we've learned these words which right, there's there's a positive is that a little bit of stigma is away. We've learned some of these words. The downside is now we're using them totally inappropriately and taking away their real meaning sometimes from people and I don't know, do the people suffering from those actually feel the disservice when they hear someone use the same word that is their diagnosis in a meaningful way in something much less meaningful for others. So, when it comes down to that spectrum, what is language that we use and should we be teaching sensitivity in schools, in shul and really where probably most at the dinner table when we hear each other, not only children, adults also. When we use those words, let's correct or remind one another cuz it how how much does that contribute in an unhealthy way? Yeah, I I think that's a really important point and it's a really rich point because I think it's one of those, you know, I I know that you also love to talk about nuance. You know, some things are not black and white. They're not, you know, okay, it's all good or it's all bad. I think the fact that young people and lay people are now familiar with a lot of this these clinical concepts and terms is really really helpful as far as being able to provide support and treatment and intervention for people who otherwise would have just kind of completely depathologized really painful experiences. But, the flip side of it is we have a lot of people pathologizing very normative human experiences. And there are some words that can can kind of play you know, at both weddings. So, for example, the word anxious. It's not always a clinical word, right? So, if I said something like, oh, I have a speaking engagement coming up and I'm anxious to get it done with because it makes me nervous beforehand, then I'm using the word in lower case letters as, you know, a regular descript you know, descriptor like just you know, it's a feeling. So, anxiety that's not clinical is part of the spectrum of human experience. You know, an anxiety disorder is, you know, that's a different story. That's diagnosable, that's treatable. Sometimes we medicate, right? That's a different thing. And there's a little bit of a not a little bit, there's a significant debate between a lot of clinicians where some want to really have that like hard line divide of like, no, you know, it's disrespectful to people who have had, let's say, real hardcore complex trauma or acute trauma to then call you know, what what other people will call a smaller T trauma a trauma, right? So, let's say a person is in an airplane and there's significant turbulence, like really scary turbulence and everything's like, you know, falling on the floor and breaking and everything, but like nothing happens, right? Like it's a couple minutes of the plane shaking and people screaming a little bit and and most of us I think many of us at least can relate to like, oh, that wasn't fun, right? There are people who will go through an experience like that and will be terrified to get on a plane afterwards or will have bonafide panic attacks before getting on a plane afterwards, right? So, that person might say, well, I was traumatized from the turbulence, right? And someone who is a war veteran or has gone through, you know, something that would be more like, you know, you know, more of an objective trauma that had, you know, let's say a tragedy or or a serious repercussion afterwards would be like, you can't call that trauma. Like, you don't you don't know from trauma, I know from trauma. It's what I'm saying. Not not not God forbid to make fun, but like it's it's it there's sort of this like, you know, comparative analysis. So, I think like with anything else, we have to be like sensitive and aware of the gray, right? So, the people who are like hardcore know only real trauma is trauma. Like, if that's how they feel, whether it's a, you know, a therapist or a person who's, you know, processing their own serious trauma, I want to honor that. You know, if if there's a person who is struggling with severe anxiety as a result of some what other people would call a small T trauma episode, which really does happen, then, you know, when I'm working one-on-one with that person or if I know that person socially, then I want to honor that. You know, I think there's like the same way we say there are shivin panim la'Torah. There's lots of perspectives in all kinds of chachma. You know, and I'm willing to say that it's sort of like an ever-evolving and ongoing you know, discovery of how humans experience life and each other and our emotions and I I don't think it's ever for me to to trivialize or mitigate somebody else's emotional experience. That being said, I would I I I I I'm very much in favor of educating especially children and teenagers about, you know trying to be mindful not to use mental health diagnoses as a vernacular exaggeration. So like if someone's like kind of organizing her notebooks don't these notebooks anywhere whatever organizing their stuff. They like oh I'm so OCD I like to have things a certain way. It's like no that's not OCD. You're just organized sweetie. Right or you know or people will be like oh yeah I know like she didn't eat lunch she's probably anorexic. It's like no please don't call people anorexic. They're not you know so I I think that teenagers in particular are are often prone to like use mental mental health terminology where they're really just trying to use you know regular adjective and that that I would certainly you know discourage the same way I would discourage people from saying like oh my gosh you almost gave me a heart attack. It's like well you don't know who had a cardiac episode in the room so let's not use that you know but language in general is is worth being sensitive to and caring about. Absolutely. Reinforcing your point that it's a spectrum and there are so many layers to it. That's exactly you know case in point. Alisha we thank you much for your your experience your wisdom. We really appreciate it. So much to think about and we're looking forward to producing episodes and conversations and I'm sure we'll draw from your wisdom again. So thank you. Thank you for inviting me to be with Mazel and Bracha. Always good to see you. Amen. Thank you Rabbi Goldberg. Wow what a what a great episode. Such a beautiful honor to be part of this and and really a fantastic practical perspective helpful perspectives from from all from everyone who shared this evening. I love everything and they came from their own angle. Everybody really tackled it which was really the goal. Correct correct. And hopefully you know people will really take this conversation back home with them and obviously a lot of it was a great time. It's a good opportunity to kind of reflect set some goals for the for the coming year but really the you know the solution is in our hands and there's a road map for for really a lot of these challenging issues and some of the softer issues that people are struggling with. So we're excited to to hear some feedback and and really encouraging everyone to to do the homework and and take the conversation to the next level bring it home explore with each other with your loved ones at school in shul and the next episode. Bring it up at the shabbat table. Bring up mental health. We're not asking anyone to bring their you know diagnosis their chart their medicine to the table but just the topic. Just making people feel comfortable. Let's work together to remove the stigma. So this is not a one and done. We know that in order to really make a dent or move the needle we want to keep the conversation going and make people more comfortable and remove that stigma. So we'll be coming back to you next month. Moshe what are we talking about next month? I think anxiety. Anxiety is relevant across the board. There's obviously so many different layers of anxiety. What's considered anxiety disorder or what's you know an anxious thought that that propels productivity. So we want to talk a lot about anxiety and help individuals understand their relationship with with that emotion what it is and how it you know either motivates us or or holds us back and what we can do about it. And what you can expect we're going to bring on in addition to Moshe other experts and and people who themselves are tackling have tackled or learning to manage anxiety in life so that we can learn from them and for many people who listen or for people that they know or love. So Moshe it's a real honor and a privilege to be doing this together and I hope it makes an impact. I know I learned a lot tonight. Absolutely. Thank you again for your time and this partnership is wonderful. We hope you enjoyed this episode of Out of the Shadows. To help bring the show to a wider audience please rate and review on Apple Podcasts. You can subscribe and find more episodes of Out of the Shadows on Apple Podcasts, Spotify, YouTube, or wherever you get your podcasts. For further resources be sure to check out the show notes.